The nurse is caring for a patient diagnosed with acquired immunodeficiency syndrome (AIDS) whose most recent laboratory values reveal a CD4 level less than 200. Which assessment findings require immediate intervention?

A. "I should avoid bowel irritants such as fatty or fried foods": This statement demonstrates an understanding of dietary modifications to help manage recurrent diarrhea in someone with AIDS. Avoiding bowel irritants such as fatty or fried foods can help reduce gastrointestinal distress and improve symptoms.

B. "I should eat BRAT diet such as bananas, rice, applesauce, tea, and toast": The BRAT diet (bananas, rice, applesauce, tea, and toast) is a bland diet often recommended for individuals with diarrhea because it is easy to digest and can help firm up stools. This statement indicates appropriate understanding of dietary recommendations for managing diarrhea.

C. "I should avoid foods high in calories and proteins": This statement is incorrect and requires further clarification. Individuals with AIDS, especially those experiencing recurrent diarrhea, often have increased nutritional needs due to malabsorption, increased metabolism, and the body's increased energy requirements to fight infection. Avoiding foods high in calories and proteins can lead to malnutrition and worsen the patient's condition. Therefore, this statement requires correction.

D. "I should stop smoking and keep myself hydrated": This statement is appropriate and indicates understanding of important lifestyle modifications to manage diarrhea in someone with AIDS. Smoking cessation can improve overall health, while staying hydrated is essential to prevent dehydration associated with diarrhea.

A. Following proper handwashing and use of masks: While handwashing and wearing masks are important infection control measures, they are not specific to preventing hepatitis B virus (HBV) infection. While HBV can be present in blood and certain body fluids, such as semen and vaginal fluids, the primary modes of transmission are through activities that involve percutaneous or mucosal exposure to infected blood or body fluids, such as unprotected sex, sharing needles, or accidental needlesticks. While hand hygiene and mask use are crucial in healthcare settings to prevent the transmission of various infections, including HBV, they may not offer sufficient protection against HBV transmission in all situations.

B. Avoiding chemicals that are toxic and polluted air: While avoiding toxic chemicals and polluted air is important for overall health and may support liver health indirectly, it is not directly related to preventing HBV infection. HBV is primarily transmitted through exposure to infected blood or body fluids rather than environmental factors such as air pollution or exposure to toxic chemicals.

C. Public health education and vaccination: This is the most appropriate measure for preventing HBV infection. Public health education plays a crucial role in raising awareness about the risks of HBV transmission and promoting behaviors that reduce the risk of exposure, such as safe sex practices, avoiding sharing needles, and seeking medical care for potential exposures. Additionally, vaccination against HBV is highly effective in preventing infection and is recommended for all individuals, particularly those at increased risk of exposure, such as healthcare workers, people with multiple sexual partners, and individuals who inject drugs. Vaccination not only protects vaccinated individuals but also contributes to herd immunity, reducing the overall prevalence of HBV in the population.

D. Limiting alcohol intake of red and white wine: While limiting alcohol intake is important for liver health, particularly in individuals with liver disease, it is not specifically aimed at preventing HBV infection. Excessive alcohol consumption can contribute to liver damage and may exacerbate liver disease in individuals infected with HBV. However, it does not directly address the risk of HBV transmission.